A tertiary care prospective of epidemiology and etiopathogenesis of esophageal carcinoma from Northern India

Background: Esophageal cancer is considered to be a one of the most lethal malignancy. Indian population have seen a lot of changes in the epidemiology of this deadly cancer. However very few studies have been done from northern India regarding the epidemiology and etiopathogenesis of this disease. Majority of esophageal cancers (about 90%) are either squamous cell or Adenocarcinoma. Any factor that causes chronic irritation and inflammation of the esophageal mucosa appears to increase the incidence of the esophageal. The aim of the study was to perform an epidemiological study and determine the various factors that are implicated in the pathogenesis of carcinoma esophagus.Methods: This study was conducted in the department of general surgery, Government Medical College, Jammu, as an observational prospective study. It took into account the patients from 2015 to 2020. A total of 23 patients of carcinoma oesophagus who presented to Outdoor patient wing of department of surgery were included in the study. After detailed history, examination and investigations, the various variables were extracted and data was processed.Results: In this study, the majority of people were from rural areas in their seventh decade of life with males: female ratio of 3:1. The majority of people complained of dysphagia and weight loss. The site of tumor was Gastroesophageal junction.Conclusions: This study emphasised the need of health education in our population, especially in young adults to lessen the risk factors for carcinoma esophagus.

Experience of small tissue bites with conventional tissue bites in emergency setting for midline abdominal wound closure

Background: Midline incision provides excellent access to the abdominal cavity. However, wound infection following a laparotomy can increase morbidity as well as burden on health care system. Wound prognosis can be influenced by the type of incisions, suture material and the method of closure. This study aimed to assess the outcome of midline abdominal wound closure using two different techniques of wound closure.Methods: This was a prospective observational study and consisted of 300 consecutive patients ≥18 years of age undergoing abdominal surgery through a midline incision in emergency setting. Patients who were included in the study were then randomised into two groups. In group I, midline laparotomy was closed with large tissue bites and in group II small tissue bites were used.Results: Out of 300 patients included in this study, 150 patients were subjected to large tissue bites and another 150 patients to small tissue bites. 29 patients out of 150 patients (19%) in large tissue bites group and 16 patients (11%) in small tissue bites developed surgical site infection (SSI). 23 patients out of 50 patients (15%) in large tissue bites group and 11 patients (7%) in small tissue bites developed wound dehiscence.Conclusions: In this study, we found that the patients in group II whose midline laprotomy was closed with small tissue bites had better wound outcome postoperatively in terms of wound site infection and wound dehiscence.

Clinical outcome of appendectomy: laparoscopic vs open technique

Background: Acute appendicitis is a common abdominal surgical emergency. Appendectomy has been proven to be the standard care for the treatment of acute appendicitis. Objective of the study was to compare laparoscopic and open appendectomy in terms of clinical outcome and complication rates.Methods: This was a single centric, retrospective study conducted at SKIMS, Soura from May 2018 to April 2021. Open and laparoscopic appendectomy patients were compared in terms of operative times, conversion rate, complication rates and duration of hospital stay.Results: Total 120 patients were included in this study with 40 in laparoscopic group while 80 patients in the open group. Increased operative time in laparoscopic group (p=0.033) and longer duration of hospital stay (p=0.021) with open group while as comparable complication rate in both procedures were observed. Higher rates of intra-abdominal collection in laparoscopic group as compared to open groupConclusions: Both laparoscopic and open appendectomy procedures can be performed routinely for acute appendicitis without the additional risks of complications.

Long segment “Hanging-snout” end ileosotmy a safe “Surgical disaster mitigating” technique for an “Un-brookeable” end ileum: a study of 23 cases over 12 years

Background: In 1952, Professor Bryan Brooke described his technique for everting an ileostomy in order to minimise skin excoriation1. Pouting, mucosa-everting Brooke’s ileostomy have been accepted as the best technique for stoma formation in almost all cases, save a few difficult situations – such as edematous friable bowel with bulky short mesentry! In such cases formation of standard Brooke’s ‘Pouting’ ileostomy is not only difficult, but an impossible and a dangerous surgical exercise! In these situations where the bowel is “Un-Brookeable” due to aforementioned causes. Over a period of 12 years we could device a formula – “Ray’s Criteria” to decide at operation, if a given ileum in a particular patient, is safely “Brookeable” (i.e. evertable into a neat Brooke, spouting ileostomy) or is “Un-Brookeable”.Methods: 23 patients were included in this study over 12 years, who due to the peculiarity of their body morphology (obesity or thick abdominal fat), edematous friable bowel with bulky mesentry, the ileum could not be drawn outside the abdomen and everted as Brooke’s ileostomy. The “Brookeability” of the exteriorized ileum was decided based on satisfying two issues of Ray’s criteria.Results: By using “Ray’s criteria”, we could seggregate patients safely as “Brookeable” and “Un-Brookeable”. Those deemed “Un-Brookable” underwent “Long segment Hanging snout” end ileostomy, which is the theme of our study.Conclusions: We are emphatic in stating that by using “Ray’s criteria” we could accurately segregate cases into “Brookeable” and “Un-Brookeable” ileum.

Proportion of colonic carcinoma in cases presenting with acute intestinal obstruction: a cross sectional study

Background: Acute intestinal obstruction is one of the most common emergencies encountered by the general surgeon in routine practice. Although historically, obstructed hernia has been the most common cause, recent studies have shown that adhesive intestinal obstruction is now the commonest reason. Malignant bowel obstruction is also on the rise especially with the change in dietary habits. This study aims at identifying the proportion of colonic carcinoma in cases presenting with acute intestinal obstruction.Methods: The patients with acute intestinal obstruction which was diagnosed clinically and radiologically were studied. Based on operative and clinical findings along with investigation results, the etiology was identified. The patients having colonic neoplasms were identified and the data was compared with other etiological factors to find out the proportion of colonic carcinoma in the cases.Results: The proportion of colon cancer in patients presenting with acute intestinal obstruction was around 15%. The most common cause was obstructed hernia followed by post-operative adhesions. Males were more commonly affected than females. Most of the cases underwent operative management. The most common age group affected was around 50-60 years.Conclusions: This study confirms that there is a definite rise in the number of cases of colon cancer presenting as acute intestinal obstruction. There is also a skewing of the age at presentation towards younger age groups. Small bowel obstructions were much more common mainly due to adhesions and obstructed herniae.

Short term outcome of midline laparotomies in view abdominalfascia closer

Background: This is a prospective non randomized observational comparative study for surgical site infections and surgical site occurrences after laparotomy fascia closer with two different techniques. Regular bite remains the standard of care in most hospitals. Laparotomies were done for elective and emergency cases.Methods: There were two techniques used to close abdominal wall fascia. The present study has evaluated small bite abdominal closer verses regular bite closer. Author and his team had used small bite fascia closer technique for all laparotomies, while other group of surgeons utilized regular bite fascia closer.Results: Out of 26 laparotomies in short bite closer, 8 had surgical site infections and surgical site occurrences, while 26 laparotomies in regular bite closer group had 15 patients with surgical site infections and surgical site occurrences. There is significant reduction in surgical site infection and surgical site occurrences observed in small bite abdominal closer group.Conclusions: It is recommended all laparotomies elective or emergent should be closed with small bite technique as it reduces surgical site infections and surgical site occurrences.

Analysis of intraoperative findings with clinico-pathological features in appendicitis-an observational study

Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consists of vast spectrum ranging from acute to chronic to recurrent forms however existence of recurrent and chronic appendicitis is still doubted by many. In spite of various scoring systems and appendectomy being the ultimate treatment, its timing remains still controversial especially in chronic and recurrent variants of appendicitis.Methods: A total of 100 consecutive cases of suspected appendicitis who were admitted investigated and treated at our centre were taken up for this observational study. Data pertaining to clinical, operative and histopathological findings were collected and tabulated. Mean and SD were used for continuous data and for categorical data, frequency and percentages were calculated. A chi-square test was used for categorical data to find statistical significance.Results: Per operatively the appendix appeared non-inflamed in 57% of patients suggestive of chronic (recurrent) form and inflamed in 43% of patients suggestive of an acute form of appendicitis. The histopathological studies revealed chronic inflammatory cells in 63% of the resected specimens, suggestive of chronic appendicitis and acute inflammatory cells in 37% of the specimens, suggestive of acute appendicitis.Conclusions: We conclude that the correlation of clinical findings, operative findings and the histopathological findings correlate with one another (p<0.001). The surgeon’s clinical and operative findings have specificity of around 87.30% and 90.47% respectively. Hence the diagnostic accuracy of the surgeon is directly dependent on the surgeons’ expertise and there is no substitution for an experienced surgeon’s judgement.

D-dimer as a safe, convenient and easily available biomarker, when combined with conventional sentinel node biopsy in clinically node negative breast cancer to assess metastatic disease in axilla and reduce false negative results

Background: Breast cancer is frequently associated with activation of the hemostatic system and the extent of this activation correlates with a more advanced tumor stage. D-dimer is a biomarker that indicates the activation of hemostasis and fibrinolysis.Methods: This is a prospective, observational, analytical study in which we compare plasma D-dimer levels among three groups’ i.e., healthy subjects, benign patients and breast cancer patients. We have also evaluated plasma D-dimer levels in patients with lymphadenopathy and in those patients who did not have palpable lymph nodes. Plasma D-dimer levels were further characterized based on TNM classification in breast cancer patients where quantitative D-dimer levels were correlated with clinical stage grouping.Results: Through our study we have observed that D-dimer level is inexpensive and a convenient method for diagnosis and prognosis of breast cancer. We have used a control group so as to evaluate a more accurate result. Comparison between benign and malignant lesions was made and we have achieved a significant p value, which proved our study positive for raised D-dimer levels in cancer breast.Conclusions: D-dimer proves to be a safe, convenient and easily available biomarker which can be combined with conventional sentinel node biopsy in clinically node negative breast cancer to assess metastatic disease in axilla and reduce false negative results. Plasma D-dimer level was positively correlated with clinical stage of solid cancers.

Prevalence of undiagnosed hypothyroidism in patients with gall bladder stones in Belagavi

Background: Contribution of hypothyroidism to gallstone formation is debated over years. With this background, the study intended to analyze the prevalence of undiagnosed hypothyroidism in patients with cholelithiasis. The aim is to understand the prevalence of hypothyroidism in patients with gallstones.Methods: A prospective, hospital-based study was done on 100 patients admitted for the management of gall stone disease in Belagavi. After initial screening, a detailed history was obtained with special reference to symptomatology and the risk factors as per proforma from patients meeting selection criteria. Thyroid function test was done on all eligible patients. Patients were divided into three groups of Euthyroid, Subclinical hypothyroid and clinical hypothyroidism. Statistical analysis used. Percentage of gall stones in different age groups and gender of the study population was calculated followed by prevalence of hypothyroidism and subclinical hypothyroidism in all the patients included.Results: Among the study population, 40% were male and 60% were female. 23 of them have subclinical hypothyroidism and 6 of them were diagnosed with hypothyroidism. Majority of subclinical hypothyroid patients (39.13%) were aged 41-60 years. Hypothyroid symptoms were shown by the study population with unknown thyroid status.Conclusions: The prevalence of hypothyroidism in cholelithiasis is 29% in the study and is significant. The study demands further studies to consider hypothyroidism as a cause /risk factor for biliary calculus.

Laparoscopic versus open surgery in the treatment of colorectal cancer

Because of the initial case study results suggesting high recurrence rates at port sites, adoption of the laparoscopic approach for colorectal cancer treatment was slow. Surgical resection remains the cornerstone and most important facet in management of colon cancer. The use of minimally invasive approach in colorectal surgery has been reported by several authors in the literature. Some difficult about the use of laparoscopic surgery for colorectal cancer still raises, particularly with the technique’s complexity, learning curve and longer duration. Scientific literature published from January 2010 to April 2020 was reviewed. Phase III randomized clinical trials were included. Analysis of the scientific literatures confirmed that for the curative treatment of colon and rectal cancer, laparoscopy is not inferior to open surgery with respect to overall survival, disease-free survival and rate of recurrence. Laparoscopic resection can be considered an option for the curative treatment of colon and rectal cancer; but must take into consideration surgeon experience, tumour stage and potential contraindications; and that laparoscopic resection for rectal cancer be performed only by appropriately trained surgeons.